Barbara L. Irwin, PhD, RN
Written January 1997
All people are alike in some ways and different in other ways. Some commonalities exist among people as holistic beings, including their basic needs, developmental stages and drive for affiliated-individuation. Differences among people include their genetic endowment, unique model of the world and how they adapt to stress.
Similarities Among People
Holism: Belief that people are more than the sum of their parts; that body, mind, emotion and spirit function as one unit, affecting and controlling the parts in dynamic interaction with one another; thus, conscious and unconscious processes are equally important.
Basic Needs: Based on Maslow's hierarchical ordering of basic and growth needs which drive behavior. Basic needs are only met when person perceives they are met. According to Maslow, when a need is met, it no longer exists, and growth can occur. Anxiety is secondary to unmet needs; thus when basic needs are unmet, a situation may be perceived as a threat, and physical or psychosocial distress and illness may occur. Lack of growth-need satisfaction usually provides challenging anxiety and stimulates growth. Need to know and fear of knowing are associated with meeting safety and security needs.
Affiliated-Individuation: Concept unique to MRM theory based on belief that all people have instinctual drive to be accepted and dependent on support systems throughout life, while also maintaining sense of independence and freedom. Differs from concept of interdependence.
Attachment and Loss: People have an innate drive to attach to objects that repeatedly meet their needs and they grieve the loss of any of these objects. Loss can be real, perceived or threatened. Unresolved loss leads to lack of resources to cope with daily stressors resulting in morbid grief and chronic need deficits.
Psychosocial Stages: Based on Erikson's theory, task resolution depends on degree of need satisfaction. Resolution of stage critical tasks lead to growth-promoting (trust) or growth-impeding (mistrust) residual attributes that affect one's ability to be fully functional and able to respond in a healthy way to daily stressors. As one negotiates each age-specific task, he or she gains enduring character building strengths and attitudes (virtues) such as self-control or willpower.
Cognitive Stages: Based on Piaget's theory, thinking abilities also develop in a sequential order and it is useful to understand the stages to determine what developmental stage the client might have had difficulty with or need to work on. Thus, with client education, keep information simple for a client in stage of concrete operations (develops age 7-11).
Differences Among People
Inherent Endowment: Genetic as well as prenatal and perinatal influences that affect health status.
Model of the World: A person's perspective of his or her own environment, based on past experiences, knowledge, state of life, etc.
Adaptation: The way a person responds to stressors that is health and growth-directed.
Adaptation Potential: Individual ability to cope with stressor; i.e., to mobilize resources; can be predicted with an assessment model (APAM) which delineates three categories of coping: arousal, equilibrium and impoverishment. Resources may be internal or external. Arousal reflects anxiety and tension. Equilibrium is a relatively steady state of balance and may be either adaptive or maladaptive. Whereas adaptation is positive, a maladaptive state is one in which the person is coping with stressful stimuli, but only at the cost of draining energies from another subsystem. Impoverishment is a state in which people have diminished or depleted resources to draw upon.
Stress: A general response to stressful stimuli in pattern of changes involving the endocrine, GI and lymphatic systems which Selye identified as the general adaptation syndrome (GAS). The three phases of the GAS are the alarm reaction, stage of resistance and stage of exhaustion. Stimuli may be perceived as threatening or challenging (Lazarus); stressful or distressful (Selye). Engle identifed psychological reactions to stress as with the flight or fight response. MRM theory synthesizes all of these into a more holistic view.
Self-Care: The process of managing responses to stressors. Self-care includes what we know about ourselves, our resources, and our behaviors.
Self-Care Knowledge: Information about self a person has concerning what promotes or interferes with his or her own health, growth and development; what has affected an illness or contributed to a current problem; and what is needed to promote fulfillment, effectiveness in a situation, or optimal health. Includes mind-body data.
Self-Care Resources: Internal and external sources of help for coping with stressors. Developed over time as basic needs are met and developmental tasks achieved.
Self-Care Action: Development and utilization of self-care knowledge and resources to promote optimum health. Include all conscious and unconscious behaviors directed toward health, growth, development and adaptation.
Facilitation: Helping client identify, mobilize and develop personal strengths in moving toward health.
Nurturance: Gently supporting and encouraging client to integrate all biophysical, cognitive and affective processes in movement toward health.
Unconditional Acceptance: Using empathy to fully accept person as worthy with no strings attached.
Aims of Intervention
Build Trust: Through nurse-client relationship; keep promises, meet basic physical and safety needs through being truthful and trustworthy; use touch and boost esteem needs, through affirming comments about strengths.
Promote Positive Orientation: In other words, accept client as worthwhile and facilitate ability to project oneself into a positive future through making comments about events that might occur next week, etc.
Promote Control: In other words, perceived control is the key; ask what client needs and how you can help; offer options in plan of care; recognize small accomplishments such as breathing evenly, control bleeding.
Affirm and Promote Strengths: Comment on small strengths, e.g., strong pulse, ability to void, to walk from bed to chair.
Set Mutual, Health-Directed Goals: IInvolve client in developing health directed interventions that fit within his or her model of the world.
Erickson, H., Tomlin, E. & Swain, M. (2005) (8th Printing). Modeling and role-modeling: A theory and paradigm for nursing. Cedar Park TX: EST Company. (Original printing by Prentice Hall, 1983).
Erickson, H. (Ed). (2006) Modeling and role-modeling: a view from the client's world. Cedar Park, TX: Unicorns Unlimited.
Erickson, H. (1990). Theory based nursing. In H. Erickson & C. Kinney (Ed). Modeling and role-modeling: theory, practice and research. Vol 1(1), pp. 1-27. Cedar Park, TX: The Society for the Advancement of Modeling and Role-Modeling.
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